Healthcare Provider Details

I. General information

NPI: 1265639736
Provider Name (Legal Business Name): MEJKEN THEURER, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 QUINCY AVE SUITE 101
OGDEN UT
84403-1977
US

IV. Provider business mailing address

3670 QUINCY AVE SUITE 101
OGDEN UT
84403-1977
US

V. Phone/Fax

Practice location:
  • Phone: 801-334-7798
  • Fax:
Mailing address:
  • Phone: 801-334-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125043-3501
License Number StateUT

VIII. Authorized Official

Name: MEJKEN THEURER
Title or Position: LCSW
Credential:
Phone: 801-499-6990